Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Following sensory neuropathy, anti-Hu antibody-positive paraneoplastic neurological syndrome presenting with limbic encephalitis occurs after complete remission

Yuki Fukami, M.D.1), Toshitaka Umemura, M.D.1), Tetufumi Shimono, M.D.1), Takamasa Yokoi, M.D.1), Mikiko Kamijo, M.D.1) and Toshimasa Sakakibara, M.D.1)2)

1)Department of Neurology, Chubu Rosai Hospital
2)Present Address: Department of Neurology, Owari Onsen Rehabilitation Kanie Hospital

Paraneoplastic limbic encephalitis is a rare neurological disorder that frequently precedes the detection of malignancy. We report the case of a 68-year-old male with small-cell lung cancer who developed paraneoplastic limbic encephalitis associated with presence of the anti-Hu antibody, after achieving complete remission of the tumor by chemotherapy. The patient visited our hospital because of progressive sensory disturbance of the distal extremities at 65 years of age. Though paraneoplastic sensory neuropathy was suspected, we could not find any tumor and he did not improve with steroids or immunoglobulin therapy. Chest computed tomography (CT) revealed large mediastinal lymphadenopathy. He was subsequently diagnosed with small cell lung cancer at one year and three months after the neurological symptoms occurred. As his serum analysis was positive for the anti-Hu antibody, we diagnosed paraneoplastic sensory neuropathy. The lung cancer disappeared with chemotherapy, but he had developed short-term memory loss six months later. Brain fluid attenuated inversion recovery (FLAIR) imaging showed an abnormal highintensity lesion in the left medial temporal lobe including the hippocampus. We therefore made the diagnosis of paraneoplastic limbic encephalitis following subacute sensory neuropathy associated with the anti-Hu antibody. To our knowledge, this is the first report of a patient presenting with paraneoplastic neurological syndrome in which limbic encephalitis developed after tumor disappearance. So we must recognize the possibility of neurological symptoms occurring during remission. As the mechanism of pathogenesis, delayed neuronal cell damage due to immune responses against the tumor is implicated.
Full Text of this Article in Japanese PDF (2866K)

(CLINICA NEUROL, 53: 287|292, 2013)
key words: paraneoplastic neurological syndrome, limbic encephalitis, small-cell lung cancer, anti-Hu antibody, complete remission

(Received: 8-Jul-12)